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MS research update - Who will go from one episode of symptoms to having definite MS - 12 December 2012

Clinically isolated syndrome (CIS) is the first episode of neurological symptoms which last at least 24 hours. It can be the first indication of what may turn out to be multiple sclerosis. Not everyone who experiences CIS will go on to develop MS and for some people there will be no further symptoms.

MS may be diagnosed using the McDonald criteria which aim to establish whether there has been damage to the central nervous system that is disseminated in time (more than one episode of symptoms, each lasting more than 24 hours, occuring at different dates at least 30 days apart) or disseminated in space (more than one part of the central nervous system has been damaged, usually leading to more than one kind of symptom).

The McDonald criteria use MRI evidence extensively to confirm a diagnosis of MS, together with lumbar puncture evidence in some instances. With these criteria, an MS diagnosis can be made on the basis of one relapse if the MRI evidence of further damage to the nervous system is strong.

How the study was carried out

55 women and 42 men (average age 27) with clinically isolated syndrome in Kuwait were followed every three to six months for two years. A number of factors were recorded: age when symptoms began; gender; the nature of the first symptoms; information from MRI scans of the brain and spine. Each person's case was assessed using the McDonald criteria.

What was found

59 participants with CIS (61%) had a confirmed diagnosis of MS using the McDonald criteria after an average of 10 months (it ranged from six to 14 months). Out of these, the diagnosis of 37 people (38%) satisfied the McDonald criteria based on data from their MRI scans only. The diagnosis of the remaining 22% was based on a second episode of symptoms.

The researchers found that people were more likely to convert from CIS to definite MS if they had a high number of lesions seen by MRI or if symptoms began at an earlier age. The person's gender or the nature of the initial symptoms (such as problems with vision) did not predict whether they would go on to have definite MS.

What does it mean?

Someone who experiences CIS will naturally want to know if they are likely to go on to be diagnosed with MS or whether they are likely to stay symptom free. This can help when deciding whether to begin disease modifying treatments straight away.

This study provides evidence that having first symptoms at a younger age or having evidence of damage to the central nervous system as seen by MRI predict that conversion to MS is more likely.

Alroughani R, Al Hashel J, Lamdhade S, et al.
Predictors of conversion to multiple sclerosis in patients with clinical isolated syndrome using the 2010 revised Mcdonald criteria.
ISRN Neurol. 2012;2012:792192.

You can read the full text of the article online.

More on CIS and diagnosing MS

More information about clinically isolated syndrome (CIS) and the McDonald criteria is available in the A to Z of MS.

The process of diagnosing MS can take some time and usually involves taking a history and description of the symptoms experienced, doing some neurological tests (often including for vision, balance and reflexes) and having an MRI scan. It may also include a lumbar puncture or evoked potential tests.

Research by topic areas...

Symptoms and symptom management

Thouvenot E, Mura F, De Verdal M, et al.
Ipsilateral uveitis and optic neuritis in multiple sclerosis.
Mult Scler Int. 2012;2012:372361.

Gervasoni E, Cattaneo D, Montesano A, et al.
Effects of fatigue on balance and mobility in subjects with multiple sclerosis: a brief report.
ISRN Neurol. 2012;2012:316097.

Lunde HM, Bjorvatn B, Myhr KM, et al.
Clinical assessment and management of sleep disorders in multiple sclerosis: a literature review.
Acta Neurol Scand Suppl. 2013;(196):24-30.

Disease modifying treatments

Tur C, Tintoré M, Vidal-Jordana A, et al.
Natalizumab discontinuation after PML risk stratification: outcome from a shared and informed decision.
Mult Scler. 2012 Aug;18(8):1193-6.

Assessment tools

Ryan JJ, Gontkovsky ST, Kreiner DS, et al.
Wechsler Adult Intelligence Scale-Fourth Edition performance in relapsing-remitting multiple sclerosis.
J Clin Exp Neuropsychol. 2012;34(6):571-9

Moodie J, Healy BC, Buckle GJ, et al.
Magnetic resonance disease severity scale (MRDSS) for patients with multiple sclerosis: a longitudinal study.
J Neurol Sci. 2012 Apr 15;315(1-2):49-54.

Fanchamps MH, Gensicke H, Kuhle J, et al.
Screening for balance disorders in mildly affected multiple sclerosis patients.
J Neurol.2012 Jul;259(7):1413-9.

Causes of MS

Virtanen JO, Jacobson S.
Viruses and multiple sclerosis.
CNS Neurol Disord Drug Targets. 2012 Aug;11(5):528-44.

Vitamin D

Ho SL, Alappat L, Awad AB.
Vitamin D and multiple sclerosis.
Crit Rev Food Sci Nutr. 2012;52(11):980-7

Peterlik M.
Vitamin D insufficiency and chronic diseases: hype and reality.
Food Funct. 2012 Aug;3(8):784-94.


Bergvall N, Tambour M, Henriksson F, et al.
Cost-minimization analysis of fingolimod compared with natalizumab for the treatment of relapsing-remitting multiple sclerosis in Sweden.
J Med Econ. 2012 Dec 4. [Epub ahead of print]

Bandari DS, Sternaman D, Chan T, et al.
Evaluating risks, costs, and benefits of new and emerging therapies to optimize outcomes in multiple sclerosis.
J Manag Care Pharm. 2012 Dec;18(9):1-17.

Péntek M, Gulácsi L, Rózsa C, et al.
Health status and costs of ambulatory patients with multiple sclerosis in Hungary.
Ideggyogy Sz. 2012 Sep 30;65(9-10):316-24.


Patrucco L, Rojas JI, Cristiano E.
Assessing the value of spinal cord lesions in predicting development of multiple sclerosis in patients with clinically isolated syndromes.
J Neurol. 2012 Jul;259(7):1317-20.


Vickers MH.
Antenarratives to inform health care research: exploring workplace illness disclosure for people with multiple sclerosis (MS).
J Health Hum Serv Adm. 2012 Fall;35(2):170-206.

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